Threating swelling in the upper respiratory tract

Introduction Hypothyroidism is a functional disorder with characteristically elevated TSH and low thyroid hormone levels. Myxedema presents itself as a non pitting edema, on the basis of increased concentration of glycosaminoglycans in tissue with high grade hypothyroidism. The typical location of the edema is mostly in the lower extremities (pretibial). Although sometimes atypical locations (like the airways) may also be affected.

Anamnesis A 53 year old patient presented at the emergency department in our clinic with dyspnea lasting a few hours. Clinical examination revealed a swelling of the hypopharynx on both sides. The glottis was visible and compressed.

Course of care The patient was admitted with the suspicion of a parapharyngeal abscess and received antibiotic treatment with Ampicillin/Sulbactam. Panendoscopy with incision under general anesthesia showed no evidence of an abscess. Due to the massive swelling of the pharynx, extubation was not possible. By persistent swelling of the pharynx a tracheostoma with follow-up panendoscopy was performed which continued to show no evidence of an abscess.

On the intensive ward, hypothyroidism was diagnosed on the basis of biochemical markers.

After substitution therapy with intravenous L-thyroxine the swelling of the hypopharynx decreased. The general condition of the patient improved quickly so that the tracheostoma could be closed. The patient continued to improve in a timely manner.

Conclusion Hypothryoidism may present with unusual life threatening symptoms and requires immediate diagnosis and therapy. It should be considered as a differential diagnosis in patients with atypical edema.

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Publication History

Article published online:
07 August 2020